Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages

Abstract

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2–4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Natural Sweeteners: The Relevance of Food Naturalness for Consumers, Food Security Aspects, Sustainability and Health Impacts

“…Sweeteners have long-since been the object of controversies and conflicts over the years, which have included allegations of liver and bladder toxicity, carcinogenicity, foetus malformations, along with other dangers [ 11 ]. Whereas all these allegations have been investigated, sweeteners were considered safe [ 12 ], although some loss of consumer trust remains as some are not permitted in the USA, while others are allowed in the EU (e.g., cyclamate and cyclamic acid), but are not permitted in the USA (under E 952). Hence the need for natural substitutes is crucial [ 13 ].…”

Added Sugars and Low- and No-Calorie Sweeteners in a Representative Sample of Food Products Consumed by the Spanish ANIBES Study Population

“…As their role in weight management and health remains a topic of continued debate, in 2014, a group of scientists signed the Chinchón declaration [ 24 ] which stated “the need to strengthen research on LNCS in Spain, to incentivize the monitoring of LNCS intake levels in different population groups and facilitate the execution of multidisciplinary projects on the subject”. More recently, in the Ibero–American Consensus on LNCS, a panel of worldwide experts, provided a comprehensive analysis and evaluation of the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages [ 25 ]. Amongst their conclusions, it was underlined that “LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the WHO, the US Food and Drug Administration and the European Food Safety Authority” and that “consumer education about these products must be strengthened in a rigorous, objective way, based on the best scientific evidence and regulatory processes”.…”

“…Amongst their conclusions, it was underlined that “LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the WHO, the US Food and Drug Administration and the European Food Safety Authority” and that “consumer education about these products must be strengthened in a rigorous, objective way, based on the best scientific evidence and regulatory processes”. Regarding the relative safety of consumption of LNCS, international scientific experts in food, nutrition, dietetics, endocrinology, physical activity, pediatrics, nursing, toxicology and public health developed a consensus that emphasizes the long process of scientific risk assessment that it is demanded [ 25 ]. Regulatory bodies require data on reproductive and developmental toxicity, as well as mutagenicity/genotoxicity, carcinogenicity, immunotoxicity, neurotoxicity, from a battery of acute and chronic studies before a food additive can be considered for use [ 25 ].…”

“…Regarding the relative safety of consumption of LNCS, international scientific experts in food, nutrition, dietetics, endocrinology, physical activity, pediatrics, nursing, toxicology and public health developed a consensus that emphasizes the long process of scientific risk assessment that it is demanded [ 25 ]. Regulatory bodies require data on reproductive and developmental toxicity, as well as mutagenicity/genotoxicity, carcinogenicity, immunotoxicity, neurotoxicity, from a battery of acute and chronic studies before a food additive can be considered for use [ 25 ]. Furthermore, the safety of approved compounds is continuously re-evaluated to consider new and relevant scientific data.…”

Low- and No- Calorie Sweeteners (LNCS): critical evaluation of their safety and health risks

“…Risk assessments performed by scientific committees, such as the Joint FAD/WHD Expert Committee on Food Additives (JECFA) and the European Food Safety Authority (EFSA), have demonstrated that the intake of these additives through the diet is below their respective acceptable daily intakes (ADO) levels and when they are used according to recommendations and limits to achieve their technical purpose, are considered safe (European Food Safety Authority, 2019; Food and Agriculture Drganization of The United Nations, 2019a, b; Serra-Majem et al, 2018).…”